Provider Demographics
NPI:1154424687
Name:GODIWALA, TEJAS T (MD)
Entity type:Individual
Prefix:DR
First Name:TEJAS
Middle Name:T
Last Name:GODIWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 HOUMA BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2920
Mailing Address - Country:US
Mailing Address - Phone:504-455-3987
Mailing Address - Fax:504-888-0753
Practice Address - Street 1:3941 HOUMA BLVD
Practice Address - Street 2:2B
Practice Address - City:METAIROE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-455-3987
Practice Address - Fax:504-888-0753
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06031R207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
52720Medicare ID - Type Unspecified
B64077Medicare UPIN